A Call for More Services for Families with Loved Ones with Serious Mental Illness

With all the talk about healthcare reform and budget cuts to healthcare programs, my colleague, Jerome Yoman, PhD, and I were inspired to write an editorial about the need for more family services for The Oregonian, our local newspaper. We just found out that the editorial was published in the April 10, 2012 edition!

You can read the editorial by clicking on the linked title below:

Plans for Treating Mental Illness Should Encourage Family Involvement

-By Christeine Terry, Ph.D.

Get help coping with your loved one who has persistent mental illness

Do you have a loved one with Bipolar Disorder, Schizophrenia, or another type of persistent mental illness? Having a loved one with a persistent mental illness can feel stressful and overwhelming. The mental health system can be confusing and resources can be difficult to find. I specialize in working with family members to help them develop practical and useful skills to cope with their loved one’s mental illness and improve family relationships.

I offer one-to-one or group training based on evidence-based principles shown to reduce relapses of mental health problems, and improve the well-being of family members. The training is done in a collaborative and supportive style, and is focused on the hands-on skills you can use to improve your and your loved one’s mental health. As a family member of someone with a persistent mental illness, you may have that you are to blame for your family member’s illness. You are NOT to blame for their illness, but there ARE things you can do to improve the quality of life for your family and loved one with mental illness.

Why do I use evidence-based principles in what I do?

The whole team at Portland Psychotherapy has a strong commitment to using evidence-based principles in our work. Evidence-based means that techniques, treatments, or principles were tested in rigorously controlled experimental studies, as well as in studies in settings similar to our center (i.e., outpatient treatment centers), and were shown to be effective in reducing distress, relapses, or functioning. We use what works based on scientific findings, not on fads or untested techniques. Although we have a strong commitment to evidence based principles, we work hard to flexibly tailor these principles to best meet the needs of the individual and the family.

What kinds of things will help me and my family member?

Numerous research studies have shown that certain techniques are more effective in improving your well-being and your family member’s mental health. Communication skills, particularly skills that decrease the expression of negative emotions, can decrease symptoms of and relapses of persistent mental illnesses, such as schizophrenia (Butzlaff & Hooley, 1998). Problem solving and education about mental health problems and treatments can improve your well-being and help your loved one and family resolve problems more effectively (Malouff, Thorsteinsson,  & Schutte, 2007; Dixon, Stewart, Burland, Delahanty, Lucksted et al., 2001). Self-care strategies for family members can decrease stress, anxiety, and even, health problems (Cuijpers & Stam, 2000). I help family members learn these evidence-based skills that will help you and your family member improve your lives.

What will I learn if I work with you?

If you contact me, we will schedule an initial consultation, from which we will develop a plan on how to help you with your family member. The plan could include any of the following elements:

  1. Information about the mental illness your loved one has and treatments for that mental illness.
  2. Information about the mental health system and community resources.
  3. Communication skills training to more effectively express your needs and emotions, set limits, and reward your loved one’s actions.
  4. Help with identifying limits you are comfortable with and how to reward actions that promote mental health and recovery.
  5. Problem solving skills that generate multiple solutions tailored to your unique circumstances.
  6. Realistic self-care strategies that you can implment in your life.
  7. You will also get access to a support group of families struggling with a similar situation that I run.

What can I expect during our meetings?

In the first couple of sessions we will focus on a developing a detailed understanding of your loved one’s mental health symptoms, the impact of the symptoms in your lives, and your own mental health. Then, we will create specific and action-oriented goals that we will use to evaluate our progress. The following sessions will focus on learning and practicing skills described in the section above (i.e., communication skills, problem solving, education about mental health, and self-care). You will be asked to practice the skills in between meetings so we can make any revisions or adjustments to how you use the skills.

I do my best to create a supportive and collaborative environment. I will work with you to learn and tailor the skills to your unique situation. You have valuable information and knowledge about the situation you are in. I actively seek out your contributions and experiences and incorporate them into the learning process. I work hard to create an accepting and positive environment where you can share your experiences and practice the skills. You are not defined by your difficulties, therefore, your strengths and values will also be incorporated into the training.


General Mental Health Resources

Resources for Specific Mental Health Problems

  • Schizophrenia.com has list of resources on schizophrenia and topics related to schizophrenia (e.g., schizophrenia and drug use).
  • Pendulum.org is a website that has information about Bipolar Disorder, including links to support groups.
  • Depression and Bipolar Support Alliance is a national organization for individuals with depression and Bipolar disorder. It includes a helpful tip sheet for family members of what to say and what not to say to a loved one with Bipolar Disorder.
  • The National Center for PTSD is part of the Veterans Administration dedicated to researching, educating, and treating PTSD. Although there is a strong focus on Veterans, the website includes useful information and resources on PTSD for people who are not Veterans.
  • Families for Depression Awareness is a national organization for families who have loved ones with depression.
  • Anxiety and Depression Association of America has information and resources for people with anxiety disorders or depression.
  • Substance abuse resource website at Portland Psychotherapy has links to information about, organizations, and support groups (for people with addictions and for family members of people with addictions) for addictions.

Recovery from Schizophrenia? Yes, it’s Possible!

If you live in a major city you have probably encountered a person who is dressed strangely, mumbling to himself, not making eye contact, and perhaps pacing back and forth or engaging in some other repetitive behavior. You may have sighed and felt a twinge of sympathy mixed with a sense of resignation, “this person is never going to get better” you think as you move quickly to the next place you need to be. Although the person in this example may not be diagnosed with Schizophrenia, a mental illness characterized by unusual perceptual experiences and strong beliefs that seem strange to others (e.g., being under surveillance), this person is likely suffering from some sort of serious mental illness.

While our media is often filled with stigmatizing and inaccurate portrayals of people with mental illness, I’ve been happy to see that there has also been some recent press showing a more realistic and non-stigmatizing viewpoint. For example, the New York Times is currently running a series on living with serious mental illness. The first article in the series, the revelation of Dr. Marsha Linehan’s personal struggles with serious mental illness as child and young adult, was covered in our blog in July. The second article in the series was released in early August and shares the story of Joe Holt, a computer programmer and entrepreneur, who is living with the diagnosis of Schizophrenia.

What I like about this story

Part of what I like about the NY Times story is that it nicely illustrates an idea that is increasingly being acknowledged in the treatment community — that people with serious mental illness can and do recover.  The NY Times’ story of Joe Holt also shows us that the path of recovery is not straight, that it is filled with bumps, detours, and unexpected side trips; yet, people with serious mental illness do lead productive, enriching, and fulfilling lives.

It may be shocking for you to hear that people with illnesses like Schizophrenia can recover. For the early part of my career, I was under the impression that most people diagnosed with serious mental illness had a pretty hopeless future.  I only learned that this impression is false in 2006, when I stumbled across two studies on people released from the long-term units of two New England state hospitals. One state implemented programs based on a recovery model (more on that below) and the other received more standard treatment, typically a combination of medication and supportive therapy. The results were astounding! I remember sitting there shocked as I read the results from the study over and over again. In the study that just examined the outcomes of the people who received the recovery-oriented services, the majority (68%) of people did not show symptoms of schizophrenia at the 20-year follow-up, and nearly 50% did not show any symptoms of mental illness (Harding et al., 1987)! In the study that compared the people who received recovery-oriented services vs. those who received care as usual, people who received recovery-oriented care were more likely to live on their own (over 45% were living independently, i.e., not in boarding houses or half-way homes), were more likely to be/have been employed, and had fewer mental health symptoms (DeSisto et al., 1995). Results from groundbreaking studies like these provided the momentum to create a new approach to treatment called the recovery movement or recovery model.

What is the Recovery Model?

The principles of the recovery model can be grouped into four themes:

  1. Mental health care should be person-centered and directed
  2. Mental health and recovery exist on a continuum (i.e., mental health and recovery are more than just “you’re well” or “you’re ill”)
  3. The person is more than his/her mental illness and thus, treatment is more than just management of symptoms
  4. Cultural and social identities and experiences should be incorporated into treatment (e.g., helping the person overcome stigma attached to mental illness).

The 12 principles of recovery listed by the Substance Abuse and Mental Health Services Administration (SAMHSA) are:

•There are many pathways to recovery.

•Recovery is self-directed and empowering.

•Recovery involves a personal recognition of the need for change and transformation.

•Recovery is holistic.

•Recovery has cultural dimensions.

•Recovery exists on a continuum of improved health and wellness.

•Recovery is supported by peers and allies.

•Recovery emerges from hope and gratitude.

•Recovery involves a process of healing and self-redefinition.

•Recovery involves addressing discrimination and transcending shame and stigma.

•Recovery involves (re)joining and (re)building a life in the community.

•Recovery is a reality. It can, will, and does happen.

While it may seem obvious that the 12 principles of recovery should be a part of every mental health treatment a person receives, I am glad to be part of a mental health movement and system that are  actively working to incorporate recovery principles into their treatments. I am also delighted to see that the media is starting to promote recovery (even if it is not explicitly acknowledged as such) with positive and inspiring stories about people with serious mental health conditions living with and beyond their diagnoses. If you’d like to learn more about recovery (September is Recovery Awareness Month), here are some resources:

Substance Abuse and Mental Health Services Administration

Recovery Month Website

United States Psychiatric Rehabilitation Association

National Alliance on Mental Illness (NAMI)

Oregon division of NAMI

Portland Hearing Voices (from their website:  “a community group to promote mental diversity”)


DeSisto, M. et al. (19xx). The Maine and Vermont three decade studies of serious mental illness. II.
Longitudinal course comparisons. British Medical Journal of Psychiatry, 167, 338 – 342.

Harding, C. M., Brooks, G. W., Ashikaga, T., Strauss, J. S., & Breier, A. (1987). The Vermont longitudinal study of persons with severe mental illness, I:  Methodology, study sample, and overall status 32 years later. American Journal of Psychiatry, 144, 718 – 726.